Coil migration during coronary artery fistula transcatheter embolization

Starry Homenta Rampengan; Willis Kwandou; Janry A. Pangemanan; Edmond L. Jim

doi:10.15562/bmj.v12i3.4749

Coil migration during coronary artery fistula transcatheter embolization

Starry Homenta Rampengan ,

Willis Kwandou ,

Janry A. Pangemanan ,

Edmond L. Jim ,

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DOI: https://doi.org/10.15562/bmj.v12i3.4749 |
Published: 2023-10-04

Abstract

Link of Video Abstract: https://youtu.be/qD-dDYr0m2U

Introduction: Coronary artery fistula (CAF) transcatheter coil embolization is very effective in treating symptomatic coronary fistula and has many advantages compared to the surgical approach. Although this procedure is considerably safe, some life-threatening complications, including vessel rupture, coil migration and death, could still happen. We reported an example case of coil migration into the left anterior descending (LAD) artery during transcatheter CAF embolization.

Case Description: A 61-year-old man reported recurrent episodes of typical chest pain and a history of inconclusive exercise tests. Computed tomography (CT) angiography revealed a considerable medium size complex coronary fistula from proximal LAD to main pulmonary artery (MPA), which could cause coronary steal syndrome. The patient then underwent CAF transcatheter coil embolization with 3 pushable coils. Upon delivery of the last coil, the coil suddenly migrated into proximal LAD and made the patient feel chest pain with slight ST depression on electrocardiogram (ECG) monitor lead. This coil migration was treated with a coronary stent to pin the coil into the ostial CAF and coronary vessel wall. After the procedure, the chest pain disappeared, and the ST segment on ECG resolved back to baseline.

Conclusion: Coil migration is one of the potentially life-threatening complications during transcatheter CAF coil embolization. Careful preparation in choosing the closure technique, selecting coil size, determining the landing zone and using a detachable coil in high-risk CAF anatomy is mandatory to prevent this event.

References

Faisal A, Hidayat T, Rahman MA, Utamayasa A. Successful coronary artery fistula closure using Amplatzer duct occluder II device in a 10-months-old infant. Bali Med J. 2023;12(2):2284–8.
Buccheri D, Chirco PR, Geraci S, Caramanno G, Cortese B. Coronary Artery Fistulae: Anatomy, Diagnosis and Management Strategies. Hear lung & Circ. 2018;27 8:940–51.
Al-Hijji MA, Sabbagh A El, Hajj SC El, Alkhouli MA, Sabawi B El, Cabalka AK, et al. Coronary artery fistulas: indications, techniques, outcomes, and complications of transcatheter fistula closure. JACC Cardiovasc Interv. 2021;14 13:1393–406.
Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, et al. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73(12):e81–192.
Oto A, Aytemir K, Çil B, Peynircioğlu B, Yorgun H, Canpolat U, et al. Percutaneous closure of coronary artery fistulae in adults with intermediate-term follow-up results. J Interv Cardiol. 2011;24(3):216—22.
Liu X, Zhang L, Qi Z, Fan M, Ge J. The characteristics of coronary-pulmonary artery fistulas and the effectivity of trans-catheter closure: a single center experience. J Thorac Dis. 2019;11(7):2808–15.
Armsby LR, Keane JF, Sherwood MC, Forbess JM, Perry SB, Lock JE. Management of coronary artery fistulae. Patient selection and results of transcatheter closure. J Am Coll Cardiol. 2002;39(6):1026–32.
Christmann M, Hoop R, Dave H, Quandt D, Knirsch W, Kretschmar O. Closure of coronary artery fistula in childhood: treatment techniques and long-term follow-up. Clin Res Cardiol. 2017;106(3):211—8.
Sulemankhil I, Mohamed AH, Gilani SA. Coronary-Pulmonary Artery Fistula Repair With Coil Embolization: A Single Center Experience. Cureus. 2022;14:e28407.
Mavroudis C, Backer CL, Rocchini AP, Muster AJ, Gevitz M. Coronary artery fistulas in infants and children: a surgical review and discussion of coil embolization. Ann Thorac Surg. 1997;63(5):1235–42.
Goldberg SL, Makkar R, Duckwiler G. New strategies in the percutaneous management of coronary artery fistulae: A case report. Catheter Cardiovasc Interv Off J Soc Card Angiogr Interv. 2004;61(2):227–32.
Qureshi SA. Coronary arterial fistulas. Orphanet J Rare Dis. 2006;1(1):2–7.
El-Sabawi B, Al-Hijji MA, Eleid MF, Cabalka AK, Ammash NM, Dearani JA, et al. Transcatheter closure of coronary artery fistula: A 21-year experience. Catheter Cardiovasc Interv Off J Soc Card Angiogr Interv. 2020;96(2):311–9.
Yun G, Nam TH, Chun EJ. Coronary Artery Fistulas: Pathophysiology, Imaging Findings, and Management. Radiogr a Rev Publ Radiol Soc North Am Inc. 2018;38(3):688–703.

[1] Faisal A, Hidayat T, Rahman MA, Utamayasa A. Successful coronary artery fistula closure using Amplatzer duct occluder II device in a 10-months-old infant. Bali Med J. 2023;12(2):2284–8.

[2] Buccheri D, Chirco PR, Geraci S, Caramanno G, Cortese B. Coronary Artery Fistulae: Anatomy, Diagnosis and Management Strategies. Hear lung & Circ. 2018;27 8:940–51.

[3] Al-Hijji MA, Sabbagh A El, Hajj SC El, Alkhouli MA, Sabawi B El, Cabalka AK, et al. Coronary artery fistulas: indications, techniques, outcomes, and complications of transcatheter fistula closure. JACC Cardiovasc Interv. 2021;14 13:1393–406.

[4] Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, et al. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73(12):e81–192.

[5] Oto A, Aytemir K, Çil B, Peynircioğlu B, Yorgun H, Canpolat U, et al. Percutaneous closure of coronary artery fistulae in adults with intermediate-term follow-up results. J Interv Cardiol. 2011;24(3):216—22.

[6] Liu X, Zhang L, Qi Z, Fan M, Ge J. The characteristics of coronary-pulmonary artery fistulas and the effectivity of trans-catheter closure: a single center experience. J Thorac Dis. 2019;11(7):2808–15.

[7] Armsby LR, Keane JF, Sherwood MC, Forbess JM, Perry SB, Lock JE. Management of coronary artery fistulae. Patient selection and results of transcatheter closure. J Am Coll Cardiol. 2002;39(6):1026–32.

[8] Christmann M, Hoop R, Dave H, Quandt D, Knirsch W, Kretschmar O. Closure of coronary artery fistula in childhood: treatment techniques and long-term follow-up. Clin Res Cardiol. 2017;106(3):211—8.

[9] Sulemankhil I, Mohamed AH, Gilani SA. Coronary-Pulmonary Artery Fistula Repair With Coil Embolization: A Single Center Experience. Cureus. 2022;14:e28407.

[10] Mavroudis C, Backer CL, Rocchini AP, Muster AJ, Gevitz M. Coronary artery fistulas in infants and children: a surgical review and discussion of coil embolization. Ann Thorac Surg. 1997;63(5):1235–42.

[11] Goldberg SL, Makkar R, Duckwiler G. New strategies in the percutaneous management of coronary artery fistulae: A case report. Catheter Cardiovasc Interv Off J Soc Card Angiogr Interv. 2004;61(2):227–32.

[12] Qureshi SA. Coronary arterial fistulas. Orphanet J Rare Dis. 2006;1(1):2–7.

[13] El-Sabawi B, Al-Hijji MA, Eleid MF, Cabalka AK, Ammash NM, Dearani JA, et al. Transcatheter closure of coronary artery fistula: A 21-year experience. Catheter Cardiovasc Interv Off J Soc Card Angiogr Interv. 2020;96(2):311–9.

[14] Yun G, Nam TH, Chun EJ. Coronary Artery Fistulas: Pathophysiology, Imaging Findings, and Management. Radiogr a Rev Publ Radiol Soc North Am Inc. 2018;38(3):688–703.

Coil migration during coronary artery fistula transcatheter embolization

Abstract

References

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